Organization
MO SPECIALTY DENTAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE DASCH (DIRECTOR OF PROVIDER RELATIONS)
(504) 638-0303
Entity
Organization
Contact information
Practice address
4142 KEATON CROSSING BLVD STE 10, O FALLON, MO 63368-8404
(636) 244-2620
Mailing address
1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
(615) 678-0759
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
08/05/2022
Last updated
08/05/2022
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